Lazaro Lionel E, Birnbaum Jacqueline F, Farshad-Amacker Nadja A, Helfet David L, Potter Hollis G, Lorich Dean G
*Hospital for Special Surgery and New York Presbyterian Hospital, New York, NY, Weill Medical College of Cornell University, New York, NY, Orthopaedic Trauma Service; and †Institute of Diagnostic and Interventional Radiology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland.
J Orthop Trauma. 2016 Feb;30(2):81-8. doi: 10.1097/BOT.0000000000000452.
To report outcomes of a cohort with displaced femoral neck fractures (FNFs) treated with a length/angle-stable construct augmented with an endosteal fibular allograft serving as a biologic dowel.
Prospective.
Level I Trauma Center.
The study group consists of 27 patients with isolated FNF surgically treated by a single surgeon.
Open reduction of the femoral neck, fixed with a length- and angle-stable construct of 2 fully threaded cannulated screws augmented with an endosteal fibular allograft serving as a biologic dowel.
Clinical and radiographic outcomes of the fixation construct and the viability of both the femoral head and the fibular allograft, host response to the allograft and osseous union were evaluated using a specialized sequence of contrast-enhanced magnetic resonance imaging (MRI) obtained at 3 and 12 months postoperatively.
This construct resulted in high union rates (89%; 24 of 27). Two patients suffered early catastrophic failure and 1 patient developed fracture nonunion, all of wish underwent uneventful conversion to total hip arthroplasty. Three additional patients (11%) had removal of symptomatic implants. The clinical and radiographic outcomes were excellent. Twelve-month MRIs revealed either partial or complete osseous incorporation of 86% the fibular allografts without signs of adverse reaction of the host to the allograft. Femoral head osteonecrosis segments were noted in 76% of patients on MRI; however, radiographically, there were no signs of osteonecrosis or segmental collapse.
The fibular allograft reconstructs the comminuted femoral neck, and the osteointegration overtime increases the strength of the host bone-graft interface. This added strength seems to provide the stability needed to better preserve the intraoperative reduction, obtain good outcomes, and reduce the complications associated with FNF.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
报告一组采用长度/角度稳定结构并辅以骨内膜腓骨同种异体移植作为生物销钉治疗的移位型股骨颈骨折（FNF）患者的治疗结果。
前瞻性研究。
一级创伤中心。
研究组由27例接受单名外科医生手术治疗的孤立性FNF患者组成。
切开复位股骨颈，用两枚全螺纹空心螺钉组成的长度和角度稳定结构固定，并辅以骨内膜腓骨同种异体移植作为生物销钉。
使用术后3个月和12个月获得的特定序列的对比增强磁共振成像（MRI）评估固定结构的临床和影像学结果、股骨头和腓骨同种异体移植的存活情况、宿主对同种异体移植的反应以及骨愈合情况。
该结构导致高愈合率（89%；27例中的24例）。2例患者早期发生灾难性失败，1例患者发生骨折不愈合，所有这些患者均顺利转为全髋关节置换术。另外3例患者（11%）因植入物出现症状而取出。临床和影像学结果均极佳。12个月的MRI显示86%的腓骨同种异体移植部分或完全骨整合，无宿主对同种异体移植不良反应的迹象。MRI显示76%的患者存在股骨头坏死节段；然而，在X线片上，没有骨坏死或节段性塌陷的迹象。
腓骨同种异体移植重建了粉碎性股骨颈，随着时间的推移骨整合增加了宿主骨-移植界面的强度。这种增加的强度似乎提供了更好维持术中复位、获得良好结果以及减少与FNF相关并发症所需的稳定性。
治疗性四级证据。有关证据水平的完整描述，请参阅作者指南。
